NPIMap

Individual provider Active NPI

Blake Lopez, MD

  • Emergency Medicine Physician
  • La Mesa, CA
National Provider Identifier
1962908111
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A177065 Issued in CA
Practice address
5555 Grossmont Center Dr
La Mesa, CA 91942-3019
Phone
(619) 465-0711
NPI assigned
Apr 4, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X A177065 CA Primary

Addresses

Primary practice location

5555 Grossmont Center Dr
La Mesa, CA 91942-3019

Mailing address

50 W 90TH St Apt 6B
New York, NY 10024-1564
Phone (619) 243-4901

Other practice location 1

630 W 168th St
New York, NY 10032-3725
Phone (212) 305-2862

Other practice location 2

525 E 68th St
New York, NY 10065-4870
Phone (212) 746-5454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220404002296 CA Practitioner - Emergency Medicine 5294073987 Reassigns benefits to 2 organizations
I20240109003159 NV Practitioner - Emergency Medicine 5294073987 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Human Medicine, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1525 W Cypress Creek Rd
Fort Lauderdale, FL 33309-1831

2422 Legacy Island Cir
Henderson, NV 89074-6155

898 N Pacific Coast Hwy
Suite 600
El Segundo, CA 90245-2747

Hospital & facility affiliations

  • Henderson Hospital Hospital, Henderson, NV, CCN 290057
  • Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290021
  • Spring Valley Hospital Medical Center Hospital, Las Vegas, NV, CCN 290046

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A177065CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians Associates San Jose PC Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 21, 2023 Accepting new patients
Team Physicians of Northern California Medical Group Inc Emergency Medicine CurrentSince May 1, 2022 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 21, 2023 Accepting new patients

Locations

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

2105 Forest Ave
San Jose, CA 95128
Phone (408) 947-2500

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

7230 N Decatur Blvd
Las Vegas, NV 89131
Phone (702) 534-7200

150 E Harmon Ave
Las Vegas, NV 89109
Phone (702) 546-0911

Interoperability endpoints

  • Direct secure messaging: blopez194674@santaclaravalley.direct-ci.net

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649030400000",
    "number": "1962908111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 W 90TH ST APT 6B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100241564",
            "telephone_number": "619-243-4901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423019",
            "telephone_number": "619-465-0711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "630 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323725",
            "country_code": "US",
            "telephone_number": "212-305-2862",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "525 E 68th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100654870",
            "country_code": "US",
            "telephone_number": "212-746-5454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOPEZ",
        "first_name": "BLAKE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2022-04-04",
        "certification_date": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A177065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.